Cumulative Reproductive Outcomes Across Three Embryo Transfer Cycles After Hysteroscopic Endometrial Polypectomy Using a Tissue Removal System in Infertile Women: A Single-Center Retrospective Cohort Study

Background/Objectives: This study aimed to describe cumulative reproductive outcomes across three embryo transfer (ET) cycles after hysteroscopic endometrial polypectomy using a hysteroscopic tissue removal system (HTRS) and to identify determinants of cumulative and per-cycle pregnancy. Methods: In this single-center retrospective cohort study, we included infertile women who underwent HTRS-based endometrial polypectomy between January 2023 and December 2024 and subsequently initiated at least one ET cycle. Patients were followed from ET1 through ET3. The primary endpoint was the cumulative clinical pregnancy rate (CCPR) within three ET cycles. In the observed cumulative analysis, treatment discontinuation was considered as non-pregnancy. Kaplan–Meier (KM) analysis was used to estimate the cumulative pregnancy probability, with treatment discontinuation considered as censoring. Multivariate logistic regression and generalized estimating equations were used to identify patient-level and cycle-level predictors. Results: Among 100 patients, 79 achieved clinical pregnancy within three ET cycles (CCPR 79.0%). The KM estimate at ET3 was 87.4%, and the cumulative live birth rate was 65.0%. Pregnancy rates declined with advancing maternal age (≤34 years, 91.9%; 35–39 years, 78.3%; ≥40 years, 52.9%). Maternal age independently predicted lower cumulative pregnancy and lower per-cycle pregnancy probability, whereas blastocyst transfer was associated with a higher probability of pregnancy per cycle. Conclusions: In women who underwent ET after HTRS polypectomy, cumulative pregnancy across three ET cycles was relatively high; however progression to live birth declined with advancing maternal age. As no non-surgical comparison group was included, these findings should be interpreted as descriptive rather than causal.